Part A
Conducting an unstructured interview would be critical in obtaining detailed information concerning the client. During an interview, the psychological professional prepares the appropriate questions that will help provide as much information as possible. Unstructured interviews are a type of informal interviews whereby the researcher may not utilize an interview schedule (Weiner, 2003). Unstructured interviews comprise of open-ended questions that are asked without a specific order. The main advantage in applying unstructured interviews in this case is the fact that these kinds of interviews allow for flexibility since the researcher can alter the questions as the interview progresses. The psychological professional may change the interview questions depending on answers provided by the respondent, Adrianna. Since unstructured interviews utilize open-ended questions, the respondent has room to respond in much detail. This would help in establishing the sense of the respondent in understanding the case against her. Unstructured interviews will also allow for more probing in order to get a deeper understanding of issues raised by the respondent.
Unstructured interviews are valuable in obtaining information from individual with various forms of mental health problems. Unstructured interviews are similar to the free association method, which encourages individuals to provide details of their thought patterns or what they perceive in their mind (Weiner, 2003). Unstructured interviews are mainly client-centered. The key point is to allow the client to talk freely. As the psychology professional, the key role will be to reflect Adrianna’s statement back and to encourage her to talk more about her feelings and thoughts (Weiner, 2003). The open-ended approach has little guidance as to what or how much the client says. This will encourage Adrianna to open up about her thoughts and feelings. Nonetheless, I will still apply focused questions in order to guide the interview process and the course it takes. From the case study, there is need to conduct certain psychological assessments in order to evaluate the mental status of the client. The following assessments will help in reaching a diagnosis for the client.
The Mental Status Examination (MSE) is an important psychometric instrument used in clinical psychology to evaluate the functioning levels of a client with mental health issues. The MSE can help psychology professionals in determining whether a client requires treatment and in evaluating the efficacy of current treatment practices. MSE is critical while conducting the initial interview. The MSE enables the psychology professional to draw important conclusions through observation of the client and data provision by the client. The MSE bears several categories that can help the psychology professional to draw conclusions about the client. The following is an examination of the various categories with regard to client behavior.
Appearance. While conducting the MSE, the psychology professional begins by noting the physical appearance of the client (Haddox, 1999). This may include an evaluation of the dress code, tattoos, general neatness, and unusual marks on the body. It is also important to note whether the client is cooperative or not during the interview. Additional cues to look out for include consciousness levels, posture, apparent age, self-mutilation as evidenced by scars, eye contact, and among others. Posture can help indicate anxiety levels. Eye contact can indicate whether Adrianna is comfortable in answering the interview questions.
Substance use. It is important to establish whether Adrianna has alcohol dependency and drug related problems, which could exacerbate her current situation. People may slip into alcohol dependency in order to ease anxiety or depression. Most individuals with alcohol dependency will deny they have a problem or they do not realize they have an alcohol dependency problem. The psychology professional may apply the CAGE questions set that comprises of four questions about alcohol abuse. These questions include:
- Do you ever feel the need to cut down on your drinking?
- Do people criticize your drinking to the point that you feel annoyed?
- Do you have any guilt feelings about your drinking?
- Have you ever drunk alcohol in the morning to calm you down? (Haddox, 1999).
From the vignette, Adrianna has started depending on alcohol as a way of getting sleep. This will most likely lead to addiction. When evaluating the history of drug use, the psychology professional must be aware of the terminology revolving around drug use. It is also important to be aware of the phenomenology relating to drug use. Adrianna is susceptible to drug abuse as a way of coping with her depression. It is possible she will start using hard drugs to ease her frustrations.
Suicidal ideation assessment. The risk of suicide may be high judging by the fact that Adrianna had a previous diagnosis of depression. The risk of suicide may occur when there is presence of affective disorders, personality disorders, and though disorders. Affective disorders include a range of psychiatric diseases such as depression, anxiety disorder, and bipolar disorders. Personality disorders include paranoid personality disorder, schizotypal disorder, borderline personality disorder, antisocial personality disorder, and among others. Suicidal thought patterns are common among individuals with personality issues. They can be more complex when personality issues arise from the need for revenge, punishment, and due to anger issues. In assessing the risk of suicide, the psychology professional may ask various questions. For instance, one may ask, “Have you ever thought of sleeping and never seeing another day?”
Available literature indicates that alcohol abuse increases suicidal behavior among individuals. Studies indicate that there is a high risk of suicide among alcoholics (Mackrill & Hesse, 2012). This risk is higher where an immediate family member has committed suicide. Further, studies indicate that suicide behavior may run in families. A genetic component may explain why suicide may run in families (Mackrill & Hesse, 2012). Since Adrianna’s brother committed suicide, this indicates she could also be at risk of committing suicide. There is also an increased risk of suicide since Adrianna comes from a drug-abusing family. Further, she is depending on alcohol to help her sleep. According to Albanese, Norr, Capron, Zvolensky, and Schmidt (2015), there is high suicide rate among individuals exposed to traumatic events during childhood. This puts Adrianna at high risk of committing suicide due to her traumatic childhood. Due to the above reasons, there is need for Adrianna to complete a suicidal ideation assessment to establish the risk of committing suicide.
It is critical to conduct psychological tests. Psychological testing is akin to medical testing where the major goal is to provide an accurate diagnosis of a particular condition. Similarly, psychological testing evaluates the client’s behavior in order to provide a diagnosis and guide the process of treatment. Psychological tests enable psychology professionals to identify the cause of a particular psychological condition and identify evidence-based practices of dealing with the problem. For instance, conducting psychological tests on Adrianna may help shed light on anger management issues, personality disorders, affective disorders, and other underlying concerns. Psychological tests will thus help in solving the problem or issue.
Certain formal assessment procedures may help in enhancing the understanding of problems and in directing the treatment plans. One of the assessment procedures is the 4-item Primary Care PTSD Screed for evaluating post-traumatic stress disorder. Another tool that can help in evaluating PTSD is the Posttraumatic Diagnostic Scale, which is a self-report PTSD instrument. Another important assessment procedure is the application of the DSM-IV and DSM-V in evaluating the case. The Diagnostic and Statistical Manual (DSM) of mental disorders can help in classifying various mental health disorders.
Referrals may occur if the patient does not give a positive response within a period of three months. If the patient remains a threat to others or to self, there might be need for referral to a specialist. This may help in providing a specialist opinion. The referral question may relate to the nature of the metal health disorder affecting the client. Cultural issues may be present in this case study since Adrianna’s family comes from a different cultural background from that of the US. Culture plays a significant role in shaping an individual’s mental health. For instance in some cultures, men may be expected to cope with stress more than women should.
Part B
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) is a multiaxial system for diagnosis of various psychological disorders. The DSM-IV manual addresses a person from multiple perspectives (Mash & Wolfe, 2013). The DSM-IV model provides a comprehensive overview by analyzing a complete picture of the entire set of factors relating to the mental health of an individual. The DSM-IV manual has five diagnostic axes that help in providing a comprehensive diagnosis. The following is an overview of the five axes with regard to the vignette.
Axis I: Clinical disorders
Axis I of the DSM-IV manual comprises of clinical disorders. This excludes personality disorders and intellectual disabilities since they are presumed to be stable (Mash & Wolfe, 2013). The various clinical disorders under Axis I include disorders diagnosed during infancy such as ADHD, mental retardation, autism, learning disorders, communication disorders, feeding and eating disorders during infancy, selective mutism, stereotypic movement disorder, and among others (Mash & Wolfe, 2013). The other category includes those not exclusive to children, such as mood disorders (bipolar disorders and depressive disorders), anxiety disorders (PTSD, specific phobia, obsessive-compulsive disorder, social phobia, acute stress disorder, generalized anxiety disorder, and others), sleep disorders (parasomnias and dyssomnias), and eating disorders (bulimia nervosa and anorexia nervosa) (Mash & Wolfe, 2013).
Axis II: Includes personality disorders and mental retardation
This axis helps in giving prominence to the two disorders. Most of the intellectual disabilities are diagnosed during childhood. However, it may be difficult to diagnose personality disorders during childhood (Mash & Wolfe, 2013). These become prominent during adolescence or during early adulthood. Personality disorders are more stable in adulthood. However, there are attempts to diagnose personality disorders even in young children. The various personality disorders include borderline disorder, antisocial disorder, histrionic disorder, schizoid disorder, obsessive-compulsive disorder, narcissistic disorder, schizotypal disorder, avoidant disorder, and dependent disorder (Mash & Wolfe, 2013). Personality disorders share similar characteristics. One of these characteristics is a pervasive pattern of behavior that deviates from societal norms or values. Another characteristic is unusual though patterns and feelings, which contribute to significant distress upon an individual.
Axis III: General medical conditions
This axis requires the identification of related medical conditions. The evaluation of certain medical conditions present in the client may help in getting a clear understanding of the underlying mental health disorder (Mash & Wolfe, 2013). The general medical conditions may not have a sufficient link to the underlying mental disorder. Nonetheless, the general medical conditions may be important to the overall diagnosis and treatment. In addition, the medical condition may bear a direct relationship with the mental disorder in question.
Axis IV: The psychosocial and environmental problems
This axis involves the evaluation of psychosocial and environmental problems that may be contributing to the development of disorders in Axis I and Axis II. These problems include negative life experiences, family problems, major environmental disruptions, occupational problems such as unemployment, deficiencies, incarceration, poverty, and among others (Mash & Wolfe, 2013). This axis mainly focuses on current problems or those that have occurred within the past one year. However, the axis also takes into consideration past events that have contributed to the disorder.
Axis V: global assessment of functioning
This involves examining the overall level of functioning. This axis comprises of a rating scale that ranges from 1 to 100. The psychology professional uses this scale to give the observed level of functioning of the client (Mash & Wolfe, 2013). A lower score indicates that the client has significant mental health problems that call for attention. A higher score such as 100 indicates that there are no symptoms or problems.
The following is the DSM-IV-TR diagnosis and analysis of the axes relating to the vignette.
Axis I Posttraumatic stress disorder, major depressive disorder
Axis II Obsessive compulsive disorder
Axis III Recurrent dreams of the ordeal she faced
Axis IV Death of Adrianna’s family members including her mother and brother, seeing the pimp who killed her mother, abuse she ensured as a child (rape and physical abuse by her mother), and family stress (her broken family).
Axis V GAF score of 10. This indicates that Adrianna poses a significant and persistent risk of hurting self or others. Adrianna may commit suicide or hurt others unknowingly due the severity of her mental health condition. There is need for an appropriate medical intervention to ensure that Adrianna does not pose a risk to self and others.
The diagnosis made is posttraumatic stress disorder (PTSD) and major depressive disorder. Posttraumatic stress disorder occurs to persons who have experienced severe trauma (Hyman, 2013). The diagnosis of PTSD occurs at least one month following the traumatic event. Adrianna has symptoms of PTSD. There are three major symptoms for PTSD. One of the key symptoms for individuals suffering from PTSD is re-experience of the traumatic event often through distressing recollections about the traumatic event (Hyman, 2013). This mainly occurs through nightmares and flashbacks. From the vignette, Adrianna has been having recurring dreams about the night she was sexually assaulted together with her mother, and her brother beaten. The second major symptom is avoidance of places that might rekindle memories of the trauma and emotional numbness (Hyman, 2013). Adrianna manifests these symptoms. First, she refused to go out of the house unless forced to do so by her foster parents. Second, she shot the man who supposedly killed her mother without any tinge of emotion.
Another important symptom under avoidance of places that that rekindle negative images is avoidance of routine or normal activities. Adrianna stopped attending classes after learning of her brother’s death. It was only after her psychiatrist’s intervention that she started attending classes. The third major symptom of PTSD is increased arousal, which may manifest itself in the form of inability to sleep, difficulty in concentration, and irritability (Hyman, 2013). The vignette indicates that Adrianna was unable to sleep, which made her result to taking alcohol in order to sleep. Another symptom indicating increased arousal is hypervigilance. For instance, Adrianna would check whether she locked all windows, doors, and check on her children severally. This occurred after she saw her mother’s former pimp while having dinner at a restaurant. Another symptom relating to increased arousal is reckless behavior. For instance, the shooting of the pimp can be interpreted as a reckless behavior. These symptoms clearly indicate that Adrianna was suffering from PTSD.
Adrianna seems to suffer from major depressive disorder. This means that she suffers from both PTSD and a major depression. Her case is not unique. According to Hyman (2013), major depression may result due to stressful life events. In addition, there is a close link between major depression and PTSD. This means that individuals suffering from PTSD may concurrently be diagnosed with major depressive disorder. Research by Hyman (2013) indicates that there is a co-occurrence level of 56 percent and 95 percent in a lifetime between PTSD and major depressive disorder. The high co-occurrence level of the two disorders indicates that this is not a matter of coincidence. Other possible reasons for the co-occurrence of PTSD and major depressive disorder are similar symptoms, resulting from a common reason, and sequential causation (Hyman, 2013). Sequential causation occurs when PTSD goes untreated for a long time, leading to major depressive disorder.
Adrianna shows symptoms of major depressive disorder. These symptoms include detachment, diminished interest, restricted range of affect, hopelessness, irritability, difficulty sleeping, loss of interest in various activities and hobbies, persistent sadness, and among others. It is worth noting that individuals suffering from major depressive disorder may not suffer from all of the aforementioned symptoms. Rather, they may show a few of these symptoms. Adrianna shows various symptoms. For instance, she has difficulty in sleeping. She also seems to be having episodes of sadness. She has diminished interest in attending classes. This occurred after learning about the death of her brother.
Differential diagnosis will certainly play a key role in making the final diagnosis relating to the patient’s mental health condition. Differential diagnosis involves weighing the possibility of over that of others. In the case of Adriana, she seems to be having PTSD and major depressive disorder. Available literature indicates that there is a high probability of co-occurrence of the two disorders. The rationale for diagnostic decisions involves the forensic psychologist examining the possible disorders and then making a decision about which disorder(s) to settle on. The forensic psychologist will diagnose the disorder (s) that best match the client’s symptoms. There are no significant cultural issues involved in this diagnosis. This is because there is no evidence detailing cultural influence in the development of PTSD and major depressive disorder.
Legal Theory and Application
As a psychology professional, one may explain the crime presented in the vignette through a psychological dimension. From a psychological perspective, the criminal offender is under the influence of social, biological, and psychological factors. The interplay of these factors may influence a person to commit crime. However, psychology theorists assert that even a single component could influence an individual to commit crime. The identification of the appropriate theory linking an individual to criminal behavior requires the careful examination of various factors such as the individual himself or herself, family, friends, neighborhood, school, life experiences, and among others. This section examines the vignette with regard to existing psychosocial theories. This is an attempt to explain the meaning of crime as presented in the vignette.
Several theories attempt to establish crime causation. Learning theories assert that individuals learn behaviors and gain ideas by interacting with others or from the environment. Once individuals learn new behaviors, they may engage in rule violations. Learning refers to the process of acquiring new habits and knowledge through experience (Vold, Bernard, Snipes, & Gerould, 2016). One of the popular learning theories is the differential association theory by Edwin H. Sutherland. This theory asserts that people acquire social behavior or criminal behavior through their social interactions with other people (Bartol & Bartol, 2012). The messages that people obtain by interacting with others has significant influence on behavior. If an individual receives too much negative messages there is a high possibility of acquiring negative behaviors. Sutherland identified nine key points that define the theory, among them the assertion that learning of negative behaviors occur in interpersonal groups.
Sutherland’s differential association theory can explain the criminal behavior of the three men who assaulted Adrianna’s family. The three men seem to have learned criminal behavior by coping each other, which is why they commit similar crimes and as a group. One of the key limitations of this theory is that fact that not all people who associate with criminal elements ends up acquiring criminal behavior. Moreover, arguments exist that it is possible that delinquent people will select those with similar behavioral traits or values as their friends (Vold et al., 2016). As such, the theory may fail to explain the criminal behavior of the three men. This is because there is a possibility that none of them acquired criminal behavior from another, but just a case of common interests bringing them together. Nonetheless, Sutherland’s differential association theory remains fundamental in understanding crime in the society.
Albert Bandura developed the social learning theory to explain crime. His theory is a refining of Sutherland’s differential association theory. Sutherland asserts that learning occurs in close interpersonal groups. Albert Bandura rejected this as a narrow view in social learning. He propounded the idea that learning can take place through observation of others (without developing interpersonal relationships), through interactions with the environment, and through operant conditioning (Vold et al., 2016). Other learning theorists also propound the idea that learning is not restricted to close social groups. Social learning theory can partly explain the criminal behavior of Adrianna. Sutherland’s differential association theory fails to explain Adrianna’s criminal behavior because it had nothing to do with her friends. According to social learning theory, Adrianna could have acquired the criminal behavior from the environment or through observation. This could have been from TV programs or she could have read somewhere. Learning from the environment gave her an idea of buying a gun.
A significant theory of crime is one propounded by Michael Gottfredson and Travis Hirschi, known as a general theory of crime. This theory purports to evaluate all forms of crime that occur in the society. According to the duo, individuals perpetrate crime because of deficits in self-regulation or self-control (Bartol & Bartol, 2012). Social control is internal in nature to an individual. This theory asserts that early childhood experiences has significant impacts on the individual’s ability maintain self-control (Vold et al., 2016). Social control factors include those events in early childhood that has a significant impact to an individual’s later behavior. The theory asserts that social control among individuals becomes prominent at around 8 years of age. The duo argue that ordinary crimes are simply an attempt by the offender to seek “immediate gratification of desires” but with no lasting benefits (Vold et al., 2016, p. 227). Individuals committing ordinary crimes take little time to plan. In addition, they are often impulsive, shortsighted, and insensitive.
The general theory of crime seems to explain Adrianna’s criminal behavior in the most logical manner. The theory focuses on self-control. Adrianna’s childhood was marked by significant negative experiences. The negative experiences that Adrianna faced in her childhood influenced her self-control negatively. This means that currently, Adrianna has low self-control, which indicates increased tendency to engage in criminal behavior. Due to low self-control, Adrianna is likely to engage in ordinary crimes that offer immediate gratification and short-term thrill. People with low self-control will exude impulsivity and are generally insensitive. Adrianna shows symptoms of impulsivity. She shot the pimp who killed her mother and she appears to have lost her senses while shooting him. According to Vold et al. (2016), people with low self-control may engage in analogous behaviors. Such behaviors include drinking, smoking, drunk driving, skipping classes, and others. Adrianna was already skipping classes and drinking herself to sleep.
The general theory of crime holds that poor parenting techniques contribute to low self-control among individuals. A look at Adrianna’s situation reveals that her mother had poor parenting skills due to the stresses she went through. For instance, she used to take out her anger on Adrianna and was emotionally unavailable. One of the key limitations of this theory is that it is tautological. Another limitation is that the theory claims self-control to be constant from around age 8. This has been controversial with some theorists claiming that self-control is dynamic throughout the lifespan, just like the social factors.
Another key theoretical perspective is the psychoanalytical theory of human behavior proposed by Sigmund Freud. The psychoanalytical theory explains criminal behavior as a function of drives and motives in an individual (Videbeck, 2011). According to Freud, human behavior is the result of interactions of three key components: the id, ego, and the superego. Freud applies two models to explain behavior. These include the economic model and the topographic model. The economic model proposes the ideas that the id, ego, and the superego share a constant amount of psychic energy and that behavior is under the influence of instinctual demands. Under this model, the behavior of individuals is controlled by drives. Further, behavior helps in disposing of instinctual energies in an individual. The topographic model suggests that individuals have three consciousness levels, which include the conscious, the preconscious, and the unconscious.
The conscious are those things that are within an individual’s awareness. The preconscious is the things that are not conscious but that can come into awareness through some effort (Videbeck, 2011). The unconscious comprises of things that are not within an individual’s conscious realm. According to Freud, human behavior is motivated by the subconscious thoughts and feelings. This includes those in the preconscious and unconscious levels. Freud’s psychoanalytical theory can help in explaining Adrianna’s behavior. Adrianna’s behavior is the result of preconscious and unconscious thoughts and feelings (Videbeck, 2011). It is worth noting that a person represses traumatic events in his/her life into the subconscious. These subconscious thoughts continue to motivate the behavior of an individual. Freud’s theory faces a major limitation in that there is no empirical research evidence to support its claims about the subconscious memories.
Part B
Various psycholegal standards apply to the vignette including competence to stand trial, duty to warn, and insanity standards.
Competence to stand trial. Competence to stand trial refers to the ability of the defendant to understand or comprehend the nature of the accusations brought against him or her. Competency to stand trial involves the legal determination of an individual to go through a criminal adjudication process (Weiner, 2003). In other words, this is the ability to stand trial. During trial, the testimony regarding mental and physical illness of the defendant goes as far as its influence to the mental functioning of the defendant. There are three critical elements evaluated in competency to stand trial. The first element is the ability to understand charges, the court’s adversary system (the attorney), and the role of the criminal process. The second element is the ability to understand one’s role as a defendant in the justice process. Third, the defendant should be able to understand pertinent information concerning the facts relating to the case. Competency to stand trial is different from insanity defense in that it examines the defendant’s state of the mind during trial proceedings rather than at the time of committing crime (Bartol & Bartol, 2012). This is the key difference between the two.
A landmark U.S. case relating to competency to stand trial involves Dusky v. U.S., which occurred in 1960. The case involved the defendant, Milton Dusky, accused of rape and unlawfully transporting a woman (Mossman et al., 2007). During the pre-trial process, it psychologist professionals diagnosed dusky with schizophrenic reaction. Further, it became apparent that Dusky could not help the counsel in establishing the facts of the case since he seemed delusional. Despite this evidence, the trial court convicted Dusky of rape after deciding that he was competent to stand trial. The U.S. Supreme Court reversed this decision. In the landmark ruling, the U.S. Supreme Court observed that Dusky did not have sufficient mental capacity to engage with his lawyer and neither the rational understanding about the facts of the case (Mossman et al., 2007). The matter was referred back to the lower court to determine if Dusky was competent to stand trial. Forensic mental health professionals are interested in establishing whether an individual has the mental capacity to understand rationally the facts of the case during the trial period.
Duty to warn. Duty to warn concerns the risk of dangerousness. In the current legal environment, courts require mental health professionals to give their views about the defendant’s risk of causing harm to self or others (Bartol & Bartol, 2012). Nonetheless, it has been difficult for mental health professionals to predict the risk of dangerousness among individuals. It is worth noting that the mental health professional has the right to breach confidentiality of client information if he/she learns that the client intends to commit an offense or had earlier committed an offense. The mental health professional has a duty to learn if he/she learns about the client’s intent to cause harm to a third party.
A landmark case demonstrating the duty to warn involves Tarasoff v. Regents of the University of California. In this case, Dr. Thomas Moore, a psychologist at the University of California, attended to a graduate student who confessed to him that he intended to kill his girlfriend (Sheppard, 2015). Dr. Thomas Moore took action by informing the campus police of his client’s intentions. The campus police interviewed the student about his intentions of killing his girlfriend, Tarasoff, and later released him on the promise that he would stay away from her. Dr. Thomas and the campus police did not inform Tarasoff about the threats. A few months later, the student fatally stabbed Tarasoff (Sheppard, 2015). Tarasoff’s parents brought a legal action against the regents of the University of California. The lower courts ruled in favour of the school. However, the Supreme Court of California reversed this decision, citing that Dr. Thomas Moore had a legal duty to warn the victim. Forensic mental health professionals are interested in establishing whether their client poses a danger to others.
Insanity. The insanity standard is about irrationality. The standard argues that the defendant should not be held legally accountable for his actions if the court determines that at the time of committing the offense the defendant had a serious mental issue that affected his/her judgment. This is encapsulated in M’Naghten Rule, which concludes that the defendant cannot be held legally responsible if he or she suffers from a severe mental illness that affects judgment (Bartol & Bartol, 2012). Insanity standards will only apply if there is proof that the defendant had mental incapacitation at the time of committing the crime. A popular landmark case on insanity is Durham v. United States (“Findlaw”, n.d). In this case, Durban was charged with housebreaking. However, the lower courts dismissed the insanity claim without conducting adequate tests for insanity. The Supreme Court recommended that adequate tests be conducted to evaluate whether Durham was of sound mind at the time of committing the offense.
Related: Psychopathology and Criminality
